Recent Diagnosis of BCC on nose

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Last night I was diagnosed with a BCC on the right hand side of my nose (about 4mm long 2mm wide and about a centimetre from the edge of my nostril). The dermatologist made the assessment following a visual examination with a magnifying glass (of sorts) and then proceeded to propose options for removal. At this point I was a bit shocked at the diagnosis (obviously) but also surprised at the speed at which the various removal options were being discussed. I can’t remember all the options but I do remember him mentioning a possible skin graft and a flap (?) but recommended another option….. I think an excision (?) which would involve removing a 1 cm portion of my nose! I was a bit shocked by that. I understand they have to remove an extra bit to ensure it’s completely removed but I can’t quite understand how exactly this procedure works on a nose and the resulting appearance? I’ve seen some evidence on other parts of the body whereby the skin is pulled together leaving a line scar, but on a nose I would think it would end up distorting the nose – which I think the doc did mention, and therefore he suggested some other technique. So therefore not quite sure how it would be removed? Does anyone know what they do? Do they cut a slice off at a certain depth and then let it heal somehow? For info, following the discussion I did bring up that I thought a biopsy was usually the first step to actually prove it first, before having an unnecessary bigger procedure. He agreed that this would be a sensible option (although I assume he was quite sure that it was BCC from the visual) and we have decided to go down this route first. Not sure if that is the right thing to do? I think he wanted to go straight to the full removal to save having to go through it all twice….I can see that thinking. But obviously the prospect of being slighty disfigured is leaning me towards the biopsy first. If anyone has any advice or info on this it would be greatly appreciated. Feel like it all went a bit fast and should’ve asked more questions at the time.

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  • Posted

    Hi Nora,

    Sorry to hear your predicament.

    Don't be afraid to ask more questions from the dermatology team, they will want you to understand, and they do know it's a lot to take in.

    It's your nose, and you need to know full implications of surgery.

    Mike.

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  • Posted

    Hi Nora,  I had a fifth one reoved from my nose in 2015.  This one was a skin graft but the othes were just removed and they stitched.  This one was much different.  As you must know these grow inward and this was one I had had removed but they hadn't got all of it and it started again.  They discussed every option with me and pointed me in the direction of the skin graft because there would be a large hole and could not be stitched up.  They acted very quickly, in 7 days and I had 3 operations because they had to make sure they got all of this time.  I had the graft which they took from up in my hairline and the blood vessel which was attached to it was outside my forehead and the piece was put over the hole.  I went back in 5 weeks later and they snipped the vessel at the top and bottom and I had a face again.  There is a scar down my forehead and on my nose but it was the 5th one I had had taken off.  I am pleased with the result as it could have been so much worse had I not dne anything about it.  Please don't be afraid, I can truly understand how you feel, I felt the same.  I have some make-up which I put on it and it looks good.  I don't ever sit in the sun any more because I am more scared of that.  I will be interested to know how you get on and what you choose.  Incidentally, the procedure my Surgeon did he learned in the USA.  I am thinking of you. x

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  • Posted

    Hi Nora. Ye, I'd also be reluctant tohave it done. I wonder if you shd ask your General practitioner what he thinks you shd do? he may have sent other patients to this dermatologist. I will say a prayer for you right now.

    ?harrishill

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  • Posted

    Thanks all of you for the comments. Really appreciate the feedback. So yesterday i read up on the various procedures, watched a few videos and got in contact with the plastic surgeon and discussed the procedure options in more detail. He was easier to get hold of than i thought and he took me through the proposed option that i have now agreed to. As mentioned before, i'm going to go for the biopsy first, which apparently is a punch biopsy which takes a 3-4mm piece from my nose for assessment - kind of like using a apple corer or cookie cutter type tool - you can see all this on you tube. Not great viewing but i needed to see it to feel fully informed and to be honest, not that bad really.  This wound is then left to heal naturally i.e. no stiches and scabs over apparently quite quickly. I then wait 2 weeks for the result and then if i do have BCC then they will remove 1cm of tissue by excision, which from waht i've seen is cutting a circle with a scalpel, pulling the skin up and then snipping underneath to take off a layer of skin - not sure how deep they cut, forgot to ask. Again i've been advised to then allow this to heal naturally which take the longest of all the options to heal and you have to have a dressing on for over 2 weeks (embarrasingly), but apparently the scar is the least obvious.

    I did enquire about the mohs technique, which from what i've read, is the best method for minimising the amount of tissue removed. However,  put off this method by the surgeon as it was a more expensive method and is only reserved for particular cases which apparently mine didn't warrant. Dissapointing, but what you expect from the NHS sometimes. The surgeon did say the difference in tissue removal would only be a mm or 2 so i guess that's not a massive difference. Although if funding etc was no issue, obviously everyone would be offered the mohs method. 

    Anyway, i'm going to have the biopsy - should be within the month, see what they find, and then have another discussion with the doc.

    Thanks again for the comments and advice. I'm constantly suprised, impressed and very grateful for the feedback on these forums.

     will keep this discussion updated with the progress. 

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